Satisfying sex isn’t only for the 20- and 30-something folks. As many happy
couples know, it’s possible to enjoy a healthy and satisfying sex life well
into your 40s, 50s and beyond.

But it can be complicated.

For many people, hormonal changes, chronic health conditions and medications, stress,
fatigue and midlife weight gain can thwart efforts to have healthy intimate relationships.
Many older adults report that, while they consider sex an important part of life,
they are not happy with their current sex lives.

“If you want to be sexually active, but you’re not enjoying it, it’s
important to figure out what is going on,” says Maxine Barish-Wreden, M.D.,
an integrative medicine specialist with Sutter Medical Group. “Good sex is a
huge quality of life issue. It affects the quality of our relationships and how we
feel about ourselves.”

Sometimes, the underlying issues need the attention of your doctor. But often,
your sex life can be revived with just a bit of ingenuity and patience.

Our Aging Bodies

Aging bodies go through lots of changes. As women approach menopause, their hormone
levels decrease. And it’s not just estrogen and progesterone, the “female”
hormones. Women also see drops in their levels of testosterone, the “male”
hormone that drives libido.

Some of the more noticeable effects of lower hormone levels occur in the vagina.
The vagina atrophies, losing elasticity and lubrication. It gets shorter and the walls
get thinner. That can lead to vaginal burning, painful intercourse, light bleeding
after sex, increased vulnerability to tears and infection (including urinary tract
infections), and more. A lack of sexual activity can make it even worse, as sexual
activity helps the vagina maintain tone and lubrication. With age, the urinary tract
(urethra) can also become irritated, dry or inflamed.

Many women also notice a drop in their libido, or desire for sex, and problems
getting aroused and reaching orgasm. Sometimes these issues are caused by hormonal
changes, but they can also be related to medications, and chronic health conditions
such as arthritis, depression and diabetes.

Although many women say sex over 40 is better than ever, others find themselves
avoiding it altogether. “For some, sex just isn’t worth the trouble,”
explains Dr. Barish-Wreden. “With things like loss of libido, soreness and frequent
bladder infections, there’s just not going to be a lot of satisfaction.”

Men are not immune to age-related sexual problems. Many experience lower libido
and erectile dysfunction (trouble getting or maintaining an erection). Some have trouble
reaching orgasm, as well as shorter orgasms and less forceful ejaculation. As with
women, these issues can be caused by declining hormone levels (in this case, testosterone).
They can also be related to medication side effects, chronic health conditions such
as heart disease, high blood pressure, or diabetes, depression, and more.

For both women and men, these changes can also be related to issues within the
relationship itself; if you’ve been stuck in an unfulfilling relationship for
some years, you’re not likely to feel a lot of desire for that person.

Body image can also play a role for both genders. Midlife weight gain, sags, and
wrinkles can add even more barriers to a good sex life. Some women have trouble seeing
themselves as sexual beings once they are past their childbearing years.

Non-Medical Solutions

The good news is many of these common midlife sexual frustrations can be solved.
“It’s best to start out with non-hormonal solutions,” Dr. Barish-Wreden
says. “Then, if your sex life is not getting better, talk about other options
with your doctor.”

Set an Intention

Talk to your partner; what is it that you both want? For many couples, sexual intimacy
leads to emotional intimacy, which enhances the relationship. So if libido is low,
you might have to be more intentional and more creative about setting aside time for
intimacy, rather than just waiting for it to happen. Being clear about your intention
to connect with your partner, and creating the time to do that, will benefit your
relationship in the long run.

Get to the Drugstore

Over-the-counter vaginal moisturizers and lubricants can be very helpful for women
with mild to moderate dryness. Moisturizers are typically applied every day or two,
while lubricants are used during sexual activity.

Be a Little Creative

Shake up your routine. Experiment with new activities. Try some new positions (which
might also help with pain issues). Read books, watch movies, rent a cozy cabin for
a weekend. Send your partner some unexpected texts during the day. Experiment with
vibrators and other sex toys. Do some online shopping in the privacy of your home.

Be a Little Patient

If you haven’t been sexually active in months or years, your body might have
gone through some changes without you realizing it. When sex resumes, you might find
the experience is not quite what you expected or remembered. Regular sexual activity,
with or without a partner, can help the vagina to maintain tone and lubrication, reducing
the severity of atrophy and dryness. Spending more time on foreplay might help with
desire and arousal issues. “Schedule your lovemaking for a time when you know
you’ll have plenty of time and energy and won’t be frustrated by your
body’s slower response,” Dr. Barish-Wreden says.

Get to the Gym

Losing a few pounds and getting more active can help you to feel more desirable.
Losing weight can also help with other conditions, such as high blood pressure, that
can contribute to sexual problems.

Medical Options

Dr. Barish-Wreden encourages women and men to talk openly with their doctors about
the quality of their sex lives and any problems they are having. “A good practitioner
will help you sort through problems and explore solutions,” she says.

Ask your doctor if any of your medications could be causing problems. Many common
drugs, including those used to treat depression and high blood pressure, as well as
birth control pills, are well known to have sexual side effects. You might be able
to switch to a different drug.

Ask your doctor if you should have your hormone levels tested, and if prescription
hormone replacements might help you.

Men can boost their testosterone level with injections, patches and other formulations.
(Be sure to talk with your doctor about the potential risks of taking testosterone,
including a higher risk of prostate cancer.)

For women, local hormone therapy – products that are used only in the vagina
– are often helpful in addressing vaginal menopausal symptoms that are causing
problems with sex. These products, which come in the form of vaginal rings, creams,
and tablets, supply estrogen directly to vaginal tissues and can help relieve dryness,
irritation and loss of elasticity. Little estrogen reaches the bloodstream, so the
risk associated with this kind of estrogen therapy is lower.

Women who are having other menopausal symptoms, such as severe hot flashes, along
with vaginal issues, may want to consider systemic hormone therapy. This type of hormone
therapy, in the form of pills or patches, delivers hormones throughout the body via
the bloodstream. It can help relieve many symptoms, but it may increase your risk
of other serious conditions, such as heart disease, stroke, blood clots and breast
cancer. Your doctor might suggest systemic hormone therapy only if you have very severe
symptoms of menopause.

Local treatments provide greater relief for vaginal dryness than systemic hormone
therapy, with a lower dose of hormones, Dr. Barish-Wreden says. “They are applied
directly to the vaginal tissue, so the hormones get right to where they’re needed.
That way we don’t need as high of a dosage as with a pill that has to go through
the entire body.”

Some women who have
low libido can use natural testosterone to help increase sexual desire. It can
be delivered topically or taken by mouth, and must be obtained by prescription from
a compounding pharmacy. Blood testosterone levels should be monitored, and long-term
risks of this therapy are unknown.

Women who have low sexual desire along with distress about their lack
of desire, might also want to consider a prescription medication, Addyi, that has
been approved by the FDA. Dr. Barish-Wreden notes that she is not prescribing it.
It has a large risk of side effects and offers only minimal benefits, she says. Plus,
it needs to be taken daily to produce any benefit, unlike erectile dysfunction drugs
which are taken only during sexual activity.

Your doctor can also assess whether other physical changes might be affecting your
sex life.

Some women, for example, experience pelvic organ prolapse, in which nearby organs
slip out of place and bulge into the vaginal wall. This can become worse with menopause,
as the vaginal tissue thins and has trouble supporting the area. Losing weight, treating
a chronic cough, and doing pelvic floor exercises (Kegel exercises) can help make
the pelvic floor muscles stronger (and also help with bladder control). In some women,
the vagina becomes significantly narrower; in such cases, using a series of dilators
to widen the vagina over time can help.

Men who are having trouble with erectile dysfunction, which can be caused by low
testosterone as well as other conditions, can ask their doctor about using a drug
such as Viagra or other methods to improve erections.

A Word of Caution

A word of caution about erectile dysfunction drugs: If you are resuming sexual
activity after a long hiatus, take it slow at first. For women, the joy of reconnecting
with their partners is sometimes overshadowed by resulting injuries, such as vaginal
tears.

And don’t forget about birth control. Even if you are older, until you have
gone through menopause (an entire year or more without a period), there is always
a possibility of pregnancy.

If you are developing a relationship with someone new, you’ll also need to
be careful about sexually transmitted diseases, something you might not have thought
about in years. Be sure to use safe sex practices whenever you are with a new partner.
This might be especially important for older women. An older vagina, because it often
has less lubrication and elasticity than it once did, is at greater risk of tears
and exposure to disease. To further complicate things, using a condom, the best protection
against disease, can be uncomfortable due to dryness. Your best option is to use a
latex condom along with a water-based or silicone-based lubricant (don’t use
any oil-based lubricants, such as skin lotion or baby oil, and they can break down
the condom).

Reconnect with Relationships

Sure, you are no longer 25. Sex may not be what it was back then, but it has the
potential to be something new and even better.

Try to see your middle and older years as a wonderful
opportunity, after years spent focusing on family and career. Many people, in
fact, find midlife to be a time of great sexual freedom, as the kids have left home
and pregnancy is less of a concern.

“A fair number of my patients have consciously decided to embrace the changes
and don’t have a lot of problems,” Dr. Barish-Wreden says. “There’s
a lot of freedom in leaving the childbearing years. Some of my patients are still
having happy, active sex lives, even in their 80s.”

And remember that many aspects of sexual interest and libido are in the brain,
not just the body. “Maintaining sexual interest involves enlisting a strong
mind and body connection. Take into consideration who you are now
and embrace the wisdom and experience that you’ve gained along the way,”
she says.